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Voice and Fluency > Voice Final: Neurogenic Voice Disorders_LMencini > Flashcards

Voice Final: Neurogenic Voice Disorders_LMencini Flashcards

1
Q

vocal fold paralysis: lesion sites?

A
  1. SLN damage–>cricothyroid–>monopitch
  2. Unilateral RN Damage –> 1 vf is paralyzed (dysphonia/aphonia, breathiness, hoarseness)
  3. Bilateral RN Damage –> both vf are paralyzed (abductor and adductor type)–> life threatening
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2
Q

definition: neurogenic voice disorders

A

result of impaired muscle control and innervations of muscles of respiration, phonation, and articulation

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3
Q

definition: vocal fold paralysis

A

lesions to branches of the Vagus nerve result in paresis or paralysis of corresponding muscles

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4
Q

flaccid dysarthria

A

speech symptom in Myasthenia Gravis: loss of muscle tone in the execution of motor movements

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5
Q

hypokinesia/hyperkinesia

A

symptom associated with the Extrapyramidal System seen as too little or too much movement

hypo: not enough movement (lim. range of motion)
hyper: excessive, involuntary m. spasms

hypokinetic = gen. symp in Parkinsons
hyperkinetic dysar = spasmodic dysphonia

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6
Q

irregular rhythm of repetition

A

symptom associated with the Extrapyramidal System. Not able to repeat movements @ regular pattern

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7
Q

myasthenia gravis:

system?
symptoms?

A

sys: neuromuscular junction

primary symp: fluctuating weakness and fatigue with repetitive use

speech symp: flaccid dysarthria

voice sympms: rapid vocal fatigue (breathy, weak, barely audible), fluctuating function, restoration of function after rest, hypernasality

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8
Q

Parkinson’s Disease:

symptoms?

A

general: resting tremor, muscle rigidity, hypokinesia, bradykinesia
speech: hypokinetic dysarthria

primary voice: monopitch, reduced loudness

add. voice: strain/strangle, tremor, hoarse

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9
Q

hypokinetic dysarthria

A

(speech symp. in Parkinson’s)

imprecise articulation

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10
Q

slow but regular rhythm of repetition

A

symptom assoc. with UMN. Able to perform regular movements - but slowly

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11
Q

spasticity

A

symptom assoc. with UMN. Muscle is spastic and rigid (pushing arm down eventually able to move it easier)

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12
Q

intention tremor

A

symptom assoc. with Cerebellum. Tremor is seen during voluntary movement

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13
Q

fasiculations (“bag of worms”)

A

symptom assoc with LMN. It is a sign of a muscle atrophy (dying). Twitching (can have benign fasiculation twitching)

seen in Amyotrophic lateral sclerosis (orally: on tongue)

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14
Q

extrapyramidal system:

A

checks accuracy of motor plans created by the pyramidal system. consists of: basal ganglia (striatum/globus pallidus), thalamus, and cerebellum.

“coordinating mech. for motor control”

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15
Q

fatigue with repetitive use

A

symptom assoc with Neuromuscular Junction. Rest, and start out great but then get weaker and weaker due to low amounts of acetylcholine.

seen in: primary symptom of Myasthenia Gravis

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16
Q

ataxia

A

absence of ability to sequence motor movements. Symptom associated with the Cerebellum.

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17
Q 
dystonia-
aphonia-
dysphonia-
apraxia-
ataxia-
dysarthria-
A
  1. dystonia- involuntary spasmodic contractions
  2. aphonia - complete loss of voice
  3. dysphonia - reduction of voice not completely gone
  4. apraxia - speech motor disorder that has difficulty creating plans for motor movements
  5. ataxia- speech motor disorder that has difficulty sequencing motor movements
  6. dysarthria - speech motor disorder that has difficulty executing motor movements
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18
Q

flaccidity

_____comes with it

A

reduced muscle tension/tone
–weakness

(LMN symptoms)

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19
Q

symptoms w/ cerebellum?

A

ataxia and intention tremor

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20
Q

hyperreflexia

A

symptom involving UMN. Exaggerated reflexes

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21
Q

symptoms w/ upper motor neuron (UMN)?

A

spasticity, slow but regular rhythm of repetition, and hyperreflexia

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22
Q

atrophy

A

symptom assoc with LMN. Loss of muscle mass due to not enough movement overtime

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23
Q

hyporeflexia

A

symptom assoc with LMN. Diminished reflexes

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24
Q

dysarthria vs. apraxia

A

dys= speech motor disorder that has difficulty executing motor movements

aprax= speech motor disorder that has difficulty creating motor plans for movement

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25
Q

other symptoms with myasthenia gravis?

treatment=?

A

drooping eyelid and swallowing difficulty

=poor response to treatment

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26
Q

paresis

A

weakness

27
Q

describe threat of bilateral RN damage:

A

adductor type–>both vf paralyzed in adducted position = can’t breath–> immediate threat

abductor type–> both vf are paralyzed in the abducted pos. = aspiration–> not immediate threat

(vocal fold paralysis - NVD)

28
Q

describe: fluctuating function and hypernasality

A

voice symptoms- Myasthenia Gravis

these occur because of low levels of acetylcholine making person weaker and weaker velum will continue to lower and there is fluctuating function after rest because of the low levels

29
Q

resting tremor

A

tremor seen at rest, and stops when individual engages in voluntary movement (xtra pyramidal syst)

seen in: general symp–>Parkinson’s

30
Q

symptoms with: neuromuscular junction?

A

fatigue with repetitive use

31
Q

treatment: Parkinson’s

A

special program designed for Parkinson’s
1. start out with trying to improve the speech functions the client DOES have

  1. as they advance, goal is to MAINTAIN the speech functions so that they dont deteriorate
32
Q

Parkinson’s Disease
system?
involves?
advanced stages?

A

system? Extrapyramidal system

invovles? all speech subsystems (resp., phon. artic.)

advanced? chewing and swallowing difficulty

33
Q

why do people with myasthenia gravis have poor response to treatment?

A

remember - to voice treatment

because they have very low levels of acetlycholine so they get weaker and weaker and they need medical treatment for medicine

34
Q

vocal fold paralysis:

system involved?
definition?
type of damage?

A

system? LMN

def? lesions along branches of Vagus n. resulting in paresis or paralysis of corresponding m.

type? SLN, unilateral RN, bilateral RN

35
Q

symptoms with: Lower motor neuron (LMN)?

A

flaccidity, weakness, atrophy, fasiculations (“bag of worms”), hyporeflexia

36
Q

dystonia

A

involuntary spasmodic contractions can be randomized or sustained (seen in extrapyramidal system)

37
Q

bradykinesia

A

general symptom associated with Parkinson’s disease it results in slow movements

38
Q

rigidity/excessive tension

A

symptom associated with Extrapyramidal system. It is rigid, stiff and not flexible muscles (very hard to move when pushing on them)

39
Q

symptoms with extrapyramidal system?

A 
resting tremor
spasmodic contractions
irregular rhythm of repetition
hypokinesia/hyperkinesia
dystonia
rigidity/excessive tension
40
Q

the pyramidal system:

A

responsible for creating motor plans and executing them
1. UMN: motor plan created in premotor, motor, or sensory cortex. Axons decussate in medullary pyramids. Synapse with LMN
(opp side)

  1. LMN: final common pathway. Neurons synapse with muscle fibers (same side)
41
Q

definition: neuromuscular junction

A

synapse between the Lower Motor Neuron and the muscle fibers

42
Q

Neurogenic V.D.

impairment- when?

ex?

A

can be congenital impairment or acquired

Vocal fold paralysis
Myasthenia Gravis
Parkinson's Disease
Spasmodic Dysphonia
Amyotrophic lateral sclerosis (ALS)
43
Q

neuroanatomic systems involved in voice + speech production?

A 
Extrapyramidal system (basal ganglia, thalamus)
UMN (pyramidal)
LMN (pyramidal)
Neuromuscular junction (LMN)
Cerebellum (separate system)
44
Q

decribe a motor system…

A

UMN: motor plan is created in premotor, motor, or sensory cortex. Travels down into the striatum of the basal ganglia and out the globus pallidus, then to the thalamus, and to the cerebellum all where the plan’s accuracy is being checked by the extrapyramidal system. Then plan gets sent back up to cortex and travels down the axons of the UMN to the medulla oblongata. The axons decussate in the m.pyramids and synapse with the LMN
LMN: ‘final common pathway’ last neuron traveled before synapsing with the muscle fiber

45
Q

aphasia vs. apraxia

A

aphasia = language disorder

apraxia = motor speech disorder. difficulty creating motor plans for movement

46
Q

ALS:

-symptoms?

A

(amyotrophic lateral sclerosis)

speech symptom: flaccid and/or spastic dysarthria

voice symptom: 
hypernasality
breathiness
weak voice 
monopitch
strain-strangle

swallowing symptoms:
drooling and dysphagia

47
Q

Parkinson’s Disease video:

-respiration training?

A

Respiration training:
1. work on posture -trunk and thoracic support, sit up straight (m. rigidity is cause of poor posture)

  1. Shorter phrases per breath: ideally, 8 words per respiratory phase with stress on 2nd syllable of word. but 10 is okay, it will give the louder and clearer voice still
  2. “Boom”-plan “boom” as your 10th word so you know that you won’t run out of air to finish
48
Q

a speech diagnosis for Parkinson’s would be?

A

hypokinetic dysarthria: reduced/slower movement of motor execution

49
Q

hyperkinetic dysarthria=

A

speech symptom in Spasmodic Dysphonia: too much involuntary muscle movements with motor execution

50
Q

Parkinson’s Disease video:

  1. main complaint?
  2. exercises in previous therapy?
  3. counseling?
  4. what was DAF?
A
  1. reduced loudness/ not speaking loud enough
  2. worked on taking in deeper breath and talking a little louder
  3. want to focus on improving the reduced loudness, the reduced air support, and the “blurring”
  4. Delayed Auditory Feedback: hear yourself speak with a delay and draws out vowel sounds. Why? 1. slow down speech to help with more precise articulation, and 2. drawing out vowel sounds will make all other sounds around them louder since all vowels are voiced
51
Q

blurring

A

Running of words together (Parkinson’s video)

52
Q

hypokinetic dysarthria

A

speech symptom of Parkinson’s (slower/reduced m. movements of motor execution)

53
Q

what causes the advanced stages of Parkinson’s?

A

hypokinetic muscle rigidity makes it hard for client to chew, which can lead to choking on very large pieces and increase risk of aspiration

54
Q

in the Parkinson’s disease video, why did the SLP reduce time (ms) when client used DAF?

A

because she didn’t want to slow her speech down too much (the more time in DAF the slower the speech production). She still wanted the client to sound natural

55
Q

adductor spasmodic dysphonia

A

(type of SD)
muscles of adduction are randomly contracting and it can almost sounds as if individual is stuttering (laryngeal stutter)

*a lot of muscle tension/FVF trying to touch

56
Q

abductor spasmodic dysphonia

A

(type of SD)
the muscle of abduction is randomly contracting and pulling the vf away from midline

*whispery quality

57
Q

adductor S.D. vs. abductor S.D. symptoms

A

(voice symptoms)
adductor SD: strain-strangle and tension

abductor SD: intermittent stoppages of voice and pitch breaks

58
Q

what is important to know about the voice symptom in Spasmodic Dysphonia?

A

(adductor and abductor SD)

the symptoms are not present in speech tasks that do NOT involve phonation (so not in voiceless sounds!!)

59
Q

Spasmodic Dysphonia: additional signs?

A

(neurological) :
- vocal tremor
- jaw or facial twerks
- hand or limb tremor
- hyperreflexia, etc.

60
Q

ALS stands for:

A

Amyotrophic Lateral Sclerosis

61
Q

ALS:

  • aka
  • system
  • oral examination
A
  • Lou Gehrig’s Disease
  • LMN and UMN
  • tongue fasiculations (indicating atrophy)
62
Q

how would you describe woman’s speaking in Parkinson’s video? What were some strategies?

A

lisp, words weren’t articulated clearly, hypokinetic dysarthria glottal fry

strategies: of counseling= 1. improve reduced loudness and air support and blurring, 2. DAF, and 3. respiratory training= posture, words per respiratory phase, and “boom”

63
Q

Spasmodic Dysphonia:

  • system
  • what
  • types
A
  • extrapyramidal system
  • focal dystonia of larynx (affecting only one part of body: the larynx)
  • adductor SD and abductor SD
64
Q

Parkinson’s has more ___ than ____. How does that relate to speech?

A

resting tremor than intention tremor. Relates to speech because speech is intention so you shouldn’t hear the tremor in voice

Voice and Fluency (3 decks)

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